Page 126 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Geographic Location
Offer of AS

Small area variation. No study or survey specifically addressed how small area variation might
affect the offer of AS.

Regional variation. No study or survey specifically addressed how regional variation might
affect the offer of AS.

Urban vs. rural. One survey of 231 men with prostate cancer reported that there was no
significant difference between urban and rural residents in North Carolina as to whether the
option of WW was discussed with their physicians (51.9% vs. 53.7%). 190
Acceptance of AS

Small area variation. No study or survey that specifically addressed how small area variation
might affect the acceptance of AS. One study, however, did report that there was a wide
variation in the selection of AS/WW across 36 practice sites in the United States (ranging from 0
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to 28 percent) and that this variation was not explained by known patient factors. The variation
remained after restricting the analysis to men with low-risk disease. In a multivariable analysis,
the proportion of variation for AS/WW among men with low-risk disease attributable to practice
site was 21 percent (95 percent CI 0.11, 0.37).

Regional variation. One multivariable analysis claimed that men who resided in New Jersey
versus those in California (excluding San Francisco-Oakland, San Jose, and Los Angeles) had an
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increased probability of receiving AS/WW versus any other treatments. No significant
differences were found between men in California (excluding San Francisco-Oakland, San Jose,
and Los Angeles) and men in other registries (San Francisco-Oakland, San Jose, Los Angeles,
Seattle, Detroit, Atlanta, Iowa, New Mexico, Utah, Louisiana, Connecticut, and Alaska natives).
However, another multivariable analysis reported that men in Northeast had a decreased
probability of selecting AS/WW (versus active treatments) compared with men in greater
California (excluding San Francisco, San Jose-Monterey, and Los Angeles). 180

Urban vs. rural. One multivariable analysis reported that men who resided in urban areas
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(versus rural areas) had a decreased probability of receiving AS/WW versus RP or RT. One
survey of 231 men with prostate cancer in North Carolina reported that there was a difference in
whether physician recommendation was the most influential factor in the treatment decision
between urban and rural residents (62.3 percent versus 43.9 percent, respectively; P=0.004). 190
Adherence to AS

Small area variation. No study or survey specifically addressed how small area variation might
affect adherence to AS.

Regional variation. No study or survey specifically addressed how regional variation might
affect the offer of AS.

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